早期连续性血液滤过治疗老年造影剂急性肾损伤患者的疗效观察

目的 观察造影剂导致急性肾损伤老年患者早期应用连续性血液滤过(CVVHF)治疗的疗效.方法 将造影剂引起急性肾损伤老年患者36例,随机分为常规治疗组和CVVHF组,常规治疗组给予常规治疗,CVVHF组行冠状动脉造影后2.5 h立即予CVVHF治疗12 h;观察两组患者肾功能变化、需要暂时肾替代治疗的发生率、冠状动脉造影临床相关事件(肺水肿、心肌梗死、休克)发生率以及住院期间病死率.结果 常规治疗组造影剂肾病发生率为88.9%(16/18),CVVHF组为16.7%(3/18),差异有统计学意义(χ~2=18.836,P<0.01);常规治疗组需暂时肾替代治疗的发生率为72.2%(13/18),CVVHF组为11.1%(2/18),差异有统计学意义(χ~2=13.829,P<0.01);常规治疗组造影临床相关事件发生率为83.3%(15/18),CVVHF组为22.2%(4/18),差异有统计学意义(χ~2=13.486,P<0.01);常规治疗组住院病死率为16.7%(3/18),CVVHF组为5.6%(1/18),差异无统计学意义(χ~2=1.125,P>0.05).结论 早期应用CVVHF治疗老年患者冠状动脉造影后引起的急性肾损伤,可以有效地阻止造影剂对肾功能的损害,并可明显改善患者的预后.

To observe the efficacy of early application of continuous venovenous hemofiltration in elderly patients with contrast-induced acute kidney injury

Objective To observe the efficacy of early application of continuous venovenous hemofiltration (CVVHF) in elderly patients with contrast-induced acute kidney injury (AKI) .Methods A total of 36 elderly inpatients with contrast-induced AKI were randomly divided into two groups:CVVHF group (n= 18) and routine treatment group (n = 18).The renal function, the incidences of contrast-induced nephropathy (CIN), in-hospital events (pulmonary edema, myocardial infarction and shock), temporary renal-replacement therapy and in-hospital mortality were observed.Results The incidence of CIN was higher in routine treatment group than in CVVHF group 88.9% (16/18) vs.16.7% (3/18), P<0.05].Temporary renal-replacement therapy was required in 13(72.2%) patients of routine treatment group and in 2(11.1%) patients of CVVHF group (P<0.05).The rate of in-hospital events was higher in routine treatment group than in CVVHF group 83.3%(15/18) vs.22.2% (4/18), P<0.01].In-hospital mortality rate was higher in routine treatment group than in CVVHF group 16.7%(3/18) vs.5.6%(1/18), P>0.05].Conclusions Early application of CVVHF in patients with contrast-induced AKI after percutaneous coronary intervention appears to be effective in preventing the deterioration of renal function, and it could improve in-hospital outcomes.